ILLNESS DURING TRAVELS OF PEOPLE WITH DIABETES
People with diabetes who keep an eye on themselves and use some common sense are no more likely to get ill abroad than anyone else. However, a little forward planning is prudent. Before going away, take out travel insurance. Make sure that it is the type that will cover hospital and medical expenses in the country you are visiting and that if necessary it will cover the cost of your being flown home with a medical escort. If you are planning to spend a long time in a foreign country your doctor may be able to give you the name of a local diabetologist (the International Diabetes Federation has members in virtually every country in the world).It may be useful to carry with you a letter summarizing your medical condition and medication. If you need medical help, try to find a doctor who speaks your language and make certain that he knows that you are diabetic and that you need insulin or tablets (hang on to your personal supply in case the doctor or hospital do not have that brand, and ask what dose to take). If you get very ill in a remote part of the world it may be better to be flown home, assuming that the pressure changes of air travel are not hazardous for your condition.
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NUTRITION FOR PEOPLE WITH TYPE II DIABETES: FIBRE One of the hottest topics in diabetes nutrition in recent years is the role of dietary fibre.Let’s start by saying fibre is good for you and can help lower both your blood glucose and your blood fat levels, especially if you have Type II diabetes.Now, let’s get into the details. First, what is fibre? There are two types of fibre. One is water soluble; the other is water insoluble.Fibre is found in plants, not animals. Some plants, such as vegetables and fruits, contain more fibre than others. Some are high in water-soluble fibre, some are low. All have some amount of water-insoluble fibre.Water insoluble fibre provides bulk within your digestive tract and helps your intestine to move the remains of digested food out of your body. You use this fibre to stay “regular” and to avoid constipation.Water-soluble fibre, however, has a more direct role in your life as a diabetic. This type of fibre binds with other foods, primarily carbohydrates, in the digestive tract and slows down the process of converting this food to glucose and entering the bloodstream. The result is a slower and a lower rise in blood glucose levels after eating a meal that contains a lot of fibre-rich foods.High fibre foods include dried beans, wholegrain cereals, bran and many fruits and vegetables. Each of these foods will have a different effect on your blood glucose levels. And, to make matters worse, their effects will vary when you combine them with other types of foods in a meal. Once again, you need to use your blood glucose meter to learn what effect each of these foods has on your blood glucose.Don’t rush into a high fibre diet. Too much too soon of high-fibre foods will result in a deal of digestive distress and flatulence. Be moderate and patient as you slowly build up your fibre intake.*18/210/5*

The simplest form of carbohydrate is a single sugar molecule. Chemically, this sugar molecule is known as a monosaccharide (mono meaning one, saccharide meaning sweet). Glucose is a single sugar molecule which occurs in foods and is the most common source of fuel for the cells of the human body.

If two sugar molecules are joined together, the result is a di-saccharide (di meaning two). Sucrose, or common table sugar, is a disaccharide.

Starches are long chains of sugar molecules joined together like the beads in a string of pearls. They are called polysaccharides (poly meaning many). Starches are not sweet to taste.

Dietary fibres also have a complex structure, containing many different sorts of sugar molecules. They are different from starches and sugars in that they are not broken down by human digestive enzymes. Fibre reaches the large intestine without change. Once there, bacteria begin to ferment and break down the fibres.

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Diabetes

With modern treatment a child with diabetes can live in perfect health with few restrictions of activities.

Treatment relies on daily injections of insulin, a carefully regulated diet, plenty of exercise and regular medical supervision. It is important that the child has his meals (including between meal snacks) on time, and it is usually desirable for him to have extra food or sugar before very vigorous sport, such as swimming or lengthy physical training. Beyond this he should lead as normal a life as possible and no differentiation should be made between him and other children. A child usually feels self-conscious about his diabetes and it is better not to draw undue attention to his condition. Discipline or punishment should not be different for a diabetic child except that he must not have delays in his meals, including morning and afternoon snacks.

Mealtimes for a person with diabetes can be adjusted to fit in with school routine. A child with diabetes should normally have her snacks at recess and lunch with the other children.

If the school does alter recess or lunch times, it will be helpful to warn the parents, as some adjustment in the diet or insulin may be necessary.

Even with a careful regimen, a child may have a reaction to his insulin – the so called hypoglycemic reaction or ‘hypo’. These instructions have been prepared as a guide for teachers and others if they should be responsible for a child during such a reaction.

Hypo reactions

A hypo reaction refers to the behaviour of a child when there is an over-effect of insulin.

Any unusual behaviour in a child known to have diabetes and having insulin, and who previously appeared to be normal, is most probably an insulin reaction, and treatment should be given for it at once. A child may have a different type of reaction on different occasions.

Early stages: (one or more signs may occur at the same time)

1. Unusual lack of concentration, and later listlessness or drowsiness

2. Pallor in a child who previously had a normal skin colour

3. Sweating which may not be appropriate to the weather

4. Undue stubbornness

5. Unusual difficulty in reading and perhaps in speech

6. Readiness to cry for no real reason

7. Headache

Very rarely, if appropriate treatment is not given, a reaction may become more severe.

Later stages: (most children never experience these signs, particularly if treatment for the early stages is prompt)

1. Inco-ordination of movements and unsteady gait

2. Twitching of face or limbs

3. Vomiting

4. Convulsion

5. Unconsciousness

The child may complain of any of the following: hunger, ‘jitters’, numbness and tingling of tongue and lips, double vision, headache, faintness, or sleepiness.

Time of reaction: Each type of insulin acts differently but most reactions in children occur in the hour before the meal time is due. They may occur during or after strenuous exercise.

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